Fillable Printable Own Motion Processing Flow Chart
Fillable Printable Own Motion Processing Flow Chart
Own Motion Processing Flow Chart
Claimant Suffers
Initial Work
Related Injury
Initial Claim Disabling--
Agg Rights Expire 5 Years
From First Closure OR Initial Claim
Non-Disabling--Agg Rights Expire
5 Yrs From Date of Injury or 1st
Medical Treatment
Stop--Not in
Own Motion
Jurisdiction
No
Requests
OM Relief
NC
Claim
New/Omitted Condition
initiated after agg rights
expired & “determined to be
compensable”
No
No
Yes
Yes
No
Board Issues Order
Authorizing Reopening
Is there an
"inability to
work"?
Is there a
worsening requiring
ORS 656.278(1)(a)
medical treatment?
Is claimant
in the workforce?
(Dawkins factors)
Is the proposed
treatment reasonable/
necessary?
Don't pay
timeloss
Voluntarily
Reopen OR Recommend
Reopening to the Board
Recommend
Reopen
Yes
Is claimant a
"worker" under
ORS 656.005(30)?
Voluntarily
Reopen
When Medically
Stationary, Issue
Notice of Closure and
Close Claim
Recommend
Against
Reopening
Note: "No" Response assumes that
Carrier has properly investigated
the claim and attempted to obtain
necessary information without
success. "Yes" response assumes
that Carrier has obtained the
necessary information.
Pay Timeloss Pursuant
to
ORS 656.210,
656.212(2), &
656.262(4)
Recommend Against
Reopening and
Request Director review
of medical treatment
No
No
Does the
attending physician authorize
timeloss for the hospitalization,
surgery or other curative
treatment?
No
Yes
Yes
OWN MOTION
Processing Flow Chart
"Worsened" Condition Claims
"Post-Aggravation Rights" New/
Omitted Medical Condition Claim
Issue Modified
Notice of
Acceptance (WCD’s 1502
Form not Required)
"Determined to be Compensable:"
1) Insurer does not dispute
compensability/responsibility of
current condition; or
2) Current condition denial under
ORS 656.262(6) or ORS
656.308(2) or de facto denial is set
aside.
OAR 438-012-0001(3)(a), (b)
Yes
Yes
"Post-Agg Rights"
worsened condition
claim “determined to be
compensable”
Yes
"Post Agg Rights"
Worsened Condition
Yes
Yes
Not an OM Claim - No
OM Processing
Required
No
"Determined to be Compensable:"
1) Issued NOA under ORS
656.262(7)(a); or
2) Denial under ORS 656.262(7)
or ORS 656.308(2) or de facto
denial is set aside.
OAR 438-012-0001(4)(a), (b)
Yes
Not "determined to be
compensable" -
Not an OM Claim -
No OM processing required
No
